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CLS 304 > Chapter 9 Kidney Disease > Flashcards

Chapter 9 Kidney Disease Flashcards

1
Q

Diagnosis and screening to determine kidney diseases

A
  • Abnormality in biochemical blood screen
  • functional change in glomerular filtration rate (GFR)
  • abnormality in urinalysis: proteinuria and hematuria
  • systemic disease with renal involvement: diabetes mellitus
  • symptom, physical sign, imaging
  • kidney biopsy
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2
Q

Major types based on where kidney was initially affected

A
  1. Glomerular
  2. Tubular
  3. Interstitial
  4. Vascular
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3
Q

What major type is most often immune related?

A

Glomerular

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4
Q

What major type affects proximal/distal tubules and is a result from toxic or infectious substances

A

Tubular

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5
Q

What major type is damage from neglected UTIs and result from toxic or infectious substances

A

Interstitial

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6
Q

What major type affects blood flow from the heart and reduces renal perfusion?

A

Vascular

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7
Q

Types of glomerular disorders and morphologic changes

A 
Distinct changes/damage:
- immunologic
- non-immunologic
Types:
- primary immunologic
- Secondary to systemic diseases
- hereditary
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8
Q

Immune mediated changes in glomerulus

A
  • Cellular proliferation: increased numbers of endothelial and other cells
  • Leukocyte infiltration
  • glomerular basement membrane thickening: immune complexes and diabetes
  • Hyalinization with sclerosis (scarring)
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9
Q

Clinical features of nephritis vs nephrotic diseases

A
  • Hematuria
  • proteinuria
  • Lipiduria
  • oliguria
  • Azotemia (increased blood urea nitrogen)
  • Edema
  • Hypertension
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10
Q

2 glomerular diseases

A

Nephritic and nephrotic: acute, chronic

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11
Q

Features of nephrotic syndrome

A
  • Onset: insidious
  • Edema: ++++
  • Blood pressure: normal
  • jugular venous pressure:normal/low
  • Proteinuria: ++++
  • Hematuria: may/may not occur
  • red blood cell casts: absent
  • serum albumin: low
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12
Q

Features of nephritic syndrome

A
  • Onset: abrupt
  • edema: ++
  • blood pressure: raised
  • jugular venous pressure: raised
  • proteinuria: ++
  • hematura: +++
  • Red blood cell casts: present
  • serum albumin: normal/ slightly reduced
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13
Q

Cause of nephrotic syndrome

A

Increased permeability of the glomerular due to damage of basal Lamina and podocytes. Massive loss of protein (mostly albumin) in urine

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14
Q

Clinical findings of nephrotic syndrome

A

Pronounced soft and pitting edema and hyperlipidemia

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15
Q

Urinalysis of nephrotic syndrome

A

Cloudy, fat droplets

  • protein > 3.5g/day and 4+ positive on dipstick
  • lipiduria
  • oily
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16
Q

Microscopic findings of nephrotic syndrome

A
  • Oval fat bodies, free fat globes
  • increased renal tubular epithelial cells
  • increased casts: all types, particularly fatty, waxy, and renal well
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17
Q

Cause of acute post streptococcal glomerutonephritis

A

Sudden onset occurs 1-2 weeks after group A beta-hemolytic strep with M protein infection of throat or skin (strep throat)

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18
Q

Clinical findings of acute post streptococcal glomerulonephritis

A

Fever, edema, fatigue, hypertension, Algeria, hematuria

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19
Q

Urinalysis of acute post streptococcal glomerulonephritts

A

Cloudy, red or brown

- protein ( = casts), blood ( increased ASO titer and BUN), leukocyte esterase positive (need to look at in microscopic)

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20
Q

Microscopic findings of acute Post streptococcal glomerulonephritis

A
  • Increased RBCs, often dymorphic
  • Increased WBCs
  • increased renal tubular epithelial cells
  • Increased casts: RBC, hemoglobin, granular
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21
Q
A

Normal glomerulus

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22
Q
A

Post strep glomerulus

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23
Q

Rapidly progressive crescentric (acute nephritic)

A
  • Cellular proliferation in Bowman’s space form crescents: leukocyte infiltration; fibrin deposits; damages to glomerular basement membrane
  • Complication of systemic lupus erythematosis
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24
Q

Minimal change disease (acute nephrotic)

A

Loss of podocyte foot processes; dysfunction of t-cell immunity; follows infections and responsible for most cases of nephrotic syndrome in children; rapid response to steroids

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25
Q

Focal glomerulosclerosis (variable)

A

Sclerotic damage to limited number of glomeruli with hyaline and lipid deposits and loss of foot processes; focal IgM and C3 deposits. Proteinuria predominant

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26
Q

Changes in glomerular membrane and cellular structures

A
  • Results in varying degrees of hematuria and proteinuria
  • thickening of membrane due to deposits of IgG immune complexes
  • alteration of cellularity of the capillary walls
  • IgA deposits on glomerular membrane 1-2 days following a mucosal infection of respiratory, gastro, or urinary tract infection from infectious agents that stimulate IgA
  • disruption and damage of podocytes
27
Q

Cause of chronic glomerulonephritis

A
  • slow and progressive damage to the glomeruli
  • leads tow chronic/end stage renal disease
  • impaired GFR
28
Q

Clinical findings of chronic glomerulonephritis

A

Edema, azotemia, hypertension, oliguria, hematuria, anemia

29
Q

Urinalysis of chronic glomerulonephritis

A

Protein > 2.5g/day, blood, leukocyte esterase positive

30
Q

Microscopic findings of chronic glomerulonephritis

A
  • Increased RBCs, often dysmorphic
  • increased WBCs
  • increased renal tubular epithelial cells
  • increased casts: all types, particularly granular, waxy, broad
31
Q

Systemic diseases associated with glomerulonephritis

A
  • Diabetes mellitus
  • autoimmune disorders: systemic lupus erythematosus (SLE), sjogren syndrome, Berger disease, IgA
  • amyloidosis
  • Infections: viral: HIV, HBV bacterial: group A strep, syphilis
  • malignancies:multiple myeloma
32
Q

Cause of acute tubular necrosis (ATN)

A

Damage to renal tubular epithelium caused by:

  • Ischemia due to decreased blood flow and lack of oxygen to RTE cells seen in shock, sepsis, trauma
  • toxic substances in urine: exogenous (antibiotics, heavy metals, organic solvents, heron, cocaine, poisons) and endogenous (myoglobin and hemoglobin)
  • can cause oliguria and acute renal failure
33
Q

Urinalysis of acute tubular necrosis (ATN)

A

Cloudy, red or brown

- protein small, blood positive

34
Q

Microscopic findings of acute tubular necrosis (ATN)

A
  • Increased RBCs, often dysmorphic
  • increased renal tubular epithelial (RTE) cells
  • Increased casts: RTE most abundant, hyaline, granular, waxy
35
Q

Tubular dysfunction examples: Fanconi syndrome

A

Loss of proximal tubular function

36
Q

Tubular dysfunction examples: impaired ability to reabsorb specific substances

A
  • Cystinosis and cystinuria amino acids

- glucose, calcium, bicarbonate, sodium, phosphate

37
Q

Tubular dysfunction examples: renal tubular acidosis

A

Inability to secrete hydrogen ions so blood is acidic but unable to produce an acid urine

38
Q

Interstitial disorders: UTI

A
  • Most common renal disease
  • lower urinary tract urethra and bladder: contaminated by fecal, to tight clothes. Most common, + leukocyte esterase and ketones
  • Upper urinary tract renal pelvis, tubules, interstitium: from antibiotics
39
Q

Interstitial disorders: cystitis

A

Ascending bacterial infection of bladder

40
Q

Interstitial disorders: urethritis

A

Infection of urethra

41
Q

Clinical findings of UTI, cystitis, urethntis

A

Cloudy, odorous

- pH alkaline, protein, blood, leukocyte esterase, nitrite

42
Q

Microscopic findings for UTI, cystitis, urethritis

A
  • Increased RBCs and WBCs
  • increased transitional epithelium cells
  • bacteria/yeasts
    Urine culture for specific ID
43
Q

Cause of pyelonephritis

A

Infection of upper urinary tract tubules/interstitium

- acute and chronic presentation

44
Q

Clinical findings of pyelonephritis

A
  • Acute sudden onset of lower back pain, urinary frequency, burning, fever, headache, general malaise
  • recurrent infections leads to chronic and can progress to renal failure
  • obstructions and bladder/ureters reflux
45
Q

Urinalysis of pyelonephritis

A

Cloudy, odorous

- protein, blood, leukocyte esterase, nitrite

46
Q

Microscopic findings of pyelonephritis

A
  • Increased WBCs and WBC casts (also granular, waxy, RTE)
  • increased RBCs
  • Bacteria
    Urine and blood cultures
47
Q

Cause of acute interstitial nephritis

A

Allergic inflammation of renal interstitium followed by inflammation of renal tubules in response to certain medications. Must common cause is acute allograft rejection of a transplanted kidney

48
Q

Clinical findings of acute interstitial nephritis

A

Sudden onset of renal symptoms, rash, fever develops app. 2 weeks after medication taken

49
Q

Urinalysis of acute interstitial nephritis

A

Protein, blood, leukocyte esterase

50
Q

Microscopic findings of acute interstitial nephritis

A
  • Increased WBCs with eosinophils
  • WBC eosinophilic cast may be present
  • increased RBCS
  • increased RTE cells
51
Q

What is normal flora and where is it found?

A
  • Candida species
  • GI tract and vagina
  • normal bacteria flora keep in control
52
Q

What causes yeasts to proliferate

A

Antibiotics, pH change, increased glucose in urine

53
Q

Cause of kidney failure

A

Failure of kidneys to maintain adequate excretory, regulatory and endocrine function. Mechanism: prerenal, renal, postrenal

54
Q

Kidney failure results in

A
  • Decrease in GFR and oliguria
  • increased nitrogenous concentrations (azotemia)
  • disturbance of fluid, acid-base and electrolyte
  • miss of up to 85% nephron function
55
Q

Chronic renal failure leads to

A

End stage kidney disease, require dialysis or kidney transplant

56
Q

What is renal lithasis

A

Kidney stones:

  • calculi, solid aggregates of mineral salts, form within the kidney
  • calcium base most frequent at 75%
  • triple phosphates, uric acid and cystine at 23%
57
Q

Factors for formation of renal lithiasis (kidney stones)

A
  • Increase in concentrations of chemical salts
  • changes in urinary pH
  • urinary stasis
  • nucleation or initial crystal formation
58
Q

Clinical findings of renal lithiasis (kidney stones)

A

Severe pain radiating from lower back to legs; hematuria present in most cases

  • small stones can be passed
  • larger stones require lithotripsy or surgery
59
Q

Types of kidney stones

A

Cystine, calcium, uric acid, struvite

60
Q
A

Cystine stone

61
Q
A

Calcium stones

62
Q
A

Uric acid stones

63
Q
A

Struvite stones

CLS 304 (8 decks)

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